Healthcare Provider Details

I. General information

NPI: 1346616117
Provider Name (Legal Business Name): LYLA VANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6833 STOCKTON BLVD SUITE 2
SACRAMENTO CA
95823-2372
US

IV. Provider business mailing address

6833 STOCKTON BLVD SUITE 2
SACRAMENTO CA
95823-2372
US

V. Phone/Fax

Practice location:
  • Phone: 916-394-0800
  • Fax: 916-429-7824
Mailing address:
  • Phone: 916-394-0800
  • Fax: 916-429-7824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: